Claims Specialist

14 hours ago


Jacksonville, Florida, United States Onslow Memorial Hospital Full time

Job Summary

The Claims Analyst Specialist is a key member of our team at Onslow Memorial Hospital, responsible for ensuring timely and accurate payment from third-party payers. This role requires a strong understanding of payer systems, billing codes, and claim formats.

Key Responsibilities

  • Track, review, and follow up on outstanding patient accounts, including timely review of Patient Accounting Desktop, Clearinghouse billing list, and Intermediary online error list.
  • Contact insurance companies and patients to resolve claim issues, file primary, secondary, and tertiary insurance, re-bills, and review payment remittance.
  • Review line item denials and claim rejections for possible appeal and/or research for resubmission.
  • Be proficient in the use of multiple payer software systems and knowledge of billing codes, including CPT, ICD10, HCPCS, Modifiers, CCI Edits, MUE Edits, and claim formats.
  • Post payments and denials to claims filed directly to a patient's account via electronic posting and manual batch posting.
  • Process requested adjustments, complete daily reconciliation of bank deposits and payment posting, and enter daily posting numbers to accounting shared spreadsheet.
  • Process refunds from credit balance report and complete insurance requests, including follow-up.
  • Interact with insurance carriers in all aspects of claim resolution and monitor and follow up on Medicare and Medicaid accounts identified by recovery audit contractors (RAC).

Qualifications

  • Three years of hospital billing experience in several financial classes preferred.
  • Two years of recent hospital cash posting experience.
  • General accounting practices required.

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